Provider Demographics
NPI:1346726049
Name:HARASTY, LYNDA SUZANNE
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:SUZANNE
Last Name:HARASTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-1525
Mailing Address - Country:US
Mailing Address - Phone:724-543-3400
Mailing Address - Fax:724-548-2859
Practice Address - Street 1:200 MARKET ST
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-1525
Practice Address - Country:US
Practice Address - Phone:724-543-3400
Practice Address - Fax:724-548-2859
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028622L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist